Understand hormones and stop being afraid of "hormones"

When it comes to hormones, many people's first impression is that they have serious side effects, such as causing obesity, dependence, and bone necrosis. People are very reluctant to hear that hormones are used to treat diseases, and even turn pale at the mention of "hormones". So, can hormones be used? And how should they be used? Today, through this article, let everyone have a new understanding of hormones.

1. What are hormones?

The "hormones" that people refer to in daily life usually refer to glucocorticoids, which belong to the adrenal cortex hormones. The main component is cortisol. It is the most important regulatory hormone for the body's stress response and the most widely used and effective anti-inflammatory and immunosuppressant in clinical practice. Common clinical glucocorticoid drugs include prednisone, methylprednisone, betamethasone, prednisolone, hydrocortisone, dexamethasone, etc., which have multiple effects such as anti-inflammatory, anti-toxic, anti-allergic, anti-shock, non-specific suppression of immunity, antipyretic and analgesic. They are important therapeutic drugs for chronic obstructive pulmonary disease, allergic diseases, severe infections, immune-related diseases, rheumatism and other diseases. With the development of immunology, there are now immunosuppressants, monoclonal antibody drugs, plasma exchange, human immunoglobulin and other options for clinical selection, but hormones still play a very important role in clinical treatment because of their definite efficacy, sufficient evidence and low price.

Many patients are reluctant to choose hormones, or even strongly reject them. This is because the pharmacological effects of hormones are complex. While hormones work, they also produce some side effects. Long-term irrational use will indeed produce serious adverse reactions. Possible side effects mainly include centripetal obesity, osteoporosis, inducing or aggravating bacterial infections, hormone-induced glaucoma, steroid diabetes, etc., which discourage many patients. But in fact, hormones are not that terrible. Some side effects will gradually decrease or disappear as the amount of hormones is reduced after the condition improves. Some side effects can also be prevented by taking some measures in advance.

2. Common adverse reactions of glucocorticoids and preventive measures

(1) Skin and appearance:

Skin thinning and ecchymosis (the most common adverse reactions), acne, mild hirsutism, facial erythema and skin purple lines, Cushingoid manifestations (buffalo hump and full moon face) and weight gain, etc. These adverse reactions can also occur at lower doses and usually disappear or alleviate gradually after stopping the drug.

Preventive measures: Eat less staple food, less greasy food, eat more vegetables, and reduce energy intake. Exercise appropriately to increase energy consumption. After the hormone is reduced and the medication is stopped, obesity, moon face, and buffalo back can all be restored. For acne, try to avoid greasy, spicy and irritating foods, and quit the habit of staying up late. Do not scratch or violently squeeze hormonal acne to avoid skin infection. Go to the dermatology clinic if necessary, and use retinoic acid drugs, vitamin B6, adapalene and other creams under the guidance of a doctor to relieve symptoms.

(2) Eyes:

Long-term use of hormones increases the risk of cataracts and glaucoma. In addition, rare ophthalmic complications such as proptosis and central and serous chorioretinopathy may occur.

Preventive measures: Have regular eye examinations. If blurred vision or eye pain occurs, see an ophthalmologist promptly. Reduce or stop taking hormones based on the ophthalmologist's advice.

(3) Cardiovascular system:

Fluid retention and hyperlipidemia caused by long-term use of corticosteroids can cause hypertension and early atherosclerotic disease. In addition, the risk of thromboembolic complications (pulmonary embolism and deep vein thrombosis) is also increased.

Preventive measures: Cardiovascular disease-related tests should be performed during use, and attention should be paid to blood pressure and volume status; hemodynamic tests, coagulation function tests, and blood gas analysis can help to detect thromboembolism at an early stage, and preventive anticoagulation therapy can be performed if necessary.

(4) Endocrine and metabolism:

Glucocorticoids can cause glucose metabolism disorders, resulting in impaired glucose tolerance or diabetes. They can also affect fat metabolism by increasing plasma cholesterol and promoting subcutaneous fat decomposition. During the use of hormones, electrolytes, blood sugar, and blood lipids should be monitored and symptomatic treatment should be given as appropriate. In addition, the use of glucocorticoids can inhibit the hypothalamus-pituitary-adrenal (HPA) axis, so attention should be paid to the withdrawal method to avoid reducing the dosage too quickly or stopping it suddenly.

Preventive measures: Strictly follow the low-salt and low-fat diet principle, and exercise appropriately. Monitor blood sugar and blood pressure regularly to detect high blood sugar and high blood pressure early; for drug-induced diabetes and high blood pressure, hypoglycemic and antihypertensive drugs can be used for treatment, but most of them can return to normal with the reduction of hormones.

(5) Digestive system:

Hormones can irritate the gastrointestinal mucosa. Their use can induce or aggravate gastritis, gastric and duodenal ulcers, and even cause gastrointestinal bleeding or perforation, and severe toxic liver damage.

Preventive measures: Try to avoid spicy and irritating foods, and avoid eating hard, cold, and indigestible foods. If you experience stomach pain, acid reflux, heartburn, etc., you can use drugs that inhibit gastric acid secretion, such as omeprazole and pantoprazole, to protect the gastric mucosa. At the same time, pay attention to whether there is any gastrointestinal bleeding such as black stools.

(6) Bones and muscles:

Osteoporosis is common in children, postmenopausal women and the elderly. In severe cases, spontaneous fractures and avascular necrosis of the bone (aseptic necrosis of the femoral head) may occur. Myopathy is a rare complication, usually manifested as proximal muscle weakness or atrophy.

Preventive measures: Calcium tablets combined with vitamin D treatment can increase bone density and prevent osteoporosis, such as calcium carbonate D3, calcitriol, etc. Appropriate intake of calcium-rich foods such as dairy products, green leafy vegetables, and soy products. At the same time, bad habits that accelerate bone loss, such as smoking and alcoholism, should be avoided. Appropriate exercise, such as brisk walking and jogging, can increase bone density. If osteoporosis has already occurred, bisphosphonates (alendronate, zoledronate, ibandronate, etc.) can be used for treatment. If the amount of hormone taken is greater than 20 mg/day for more than 5 months, regular nuclear magnetic resonance observation of femoral head changes is required. Nuclear magnetic resonance can detect femoral head lesions more accurately and earlier than X-rays and CT.

(7) Neuropsychiatric symptoms:

Hormones can easily cause excitement of the nervous system, with the main manifestations being difficulty falling asleep, frequent dreams, waking up easily, waking up early, and staying up all night, and still feeling tired after waking up. Insomnia is often accompanied by a variety of discomforts such as dizziness, headache, vertigo, palpitations, shortness of breath, irritability, and inattention. In addition, the use of hormones can cause neurological symptoms including delirium, confusion or disorientation, and psychotic symptoms such as mood instability, hypomania, and depression. Most patients have mild and reversible mental and cognitive symptoms.

Prevention: Most of these psychiatric symptoms disappear after the hormone dose is reduced or treatment is stopped. However, sometimes sleeping pills, sedatives, antipsychotics, and antidepressants are needed for treatment.

(8) Immune system:

Systemic glucocorticoids affect innate and acquired immunity, causing a dose-dependent increase in the risk of infection, such as common Staphylococcus aureus, viral and fungal infections, as well as uncommon pathogens such as tuberculosis, while inhaled and topical glucocorticoids generally do not increase the risk of systemic infection. The risk of infection can be reduced by local administration, alternate-day administration, and infection prevention measures.

Preventive measures: take a rest, add or remove clothes according to weather changes, pay attention to personal hygiene, exercise appropriately to enhance resistance, avoid crowded places, wear a mask when going out to avoid cross infection. If symptoms of infection occur, receive medication immediately.

3. Precautions when using hormones

1. The selection of hormone drugs, dosage, course of treatment, usage, and reduction and discontinuation of medication must strictly follow the doctor's instructions, and hormones should not be abused at will;

2. Long-term oral patients must remember to follow the doctor's instructions and take the medicine on time. Do not increase or decrease the dosage at will, and do not stop taking the medicine at will;

3. Patients who take medication for a long time, especially the elderly, need to get more sun exposure (patients with systemic lupus erythematosus, dermatomyositis, etc. should avoid strong sunlight), take calcium supplements appropriately, prevent osteoporosis, and regularly complete bone density and other related examinations. If bone pain and other discomfort persist, go to the hospital for treatment;

4. A low-sugar, low-salt, and low-fat diet is recommended. Pay attention to monitoring blood pressure and blood sugar during oral hormone use. If any problems are found, intervene as soon as possible.

5. The body's cortisol secretion peaks between 6 and 9 in the morning and is lowest at midnight. Taking glucocorticoids orally in the morning can achieve better therapeutic effects, and it is recommended to take it half an hour after breakfast.

Written by : Kaosail Mamtiaili, a master's student in rheumatology and immunology at the First Clinical Medical College of Xinjiang Medical University; Ji Peng, associate chief physician of the Department of Rheumatology and Immunology, the First Affiliated Hospital of Xinjiang Medical University.

Reviewer : Luo Li, Chairman of the Clinical Immunology Branch of the Xinjiang Immunology Society, Vice President of the Xinjiang Uygur Autonomous Region Immunology Society, Director of the Department of Rheumatology and Immunology, the First Affiliated Hospital of Xinjiang Medical University, Professor, and Chief Physician.